Published On: Thu, Sep 1st, 2016

NHIS charges HMOs to be innovative, flexible

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United States (U.S.)-trained bone marrow transplant surgeon and Executive Secretary of the National Health Insurance Scheme (NHIS), Prof. Usman Yusuf, has charged the 48 Health Maintenance Organisations (HMOs) in Nigeria to be innovative and nimble.

Also, the Chairperson of Avon Healthcare Limited/Chief Executive Officer of Avon Medical Services Limited, an HMO, and overseer of the healthcare investments of Heirs Holdings, Dr. Awele Vivien Elumelu, has taken up the challenge by Yusuf even as she called proper monitoring, accountability and equitable distribution of the funds within the system.

What is NHIS doing to make health insurance mandatory? Yusuf said: “Making NHIS mandatory and changing the laws have to do with the legislators and that is why I am reaching out to them. If you see I went to the House of Representatives to see the Chairman and Deputy of the House Committee on Health. And I am going to see the Speaker and the President of the Senate, and I am meeting all Governors. They need to see that there is value in doing that. We need to be able to explain to them. Remember they are the people that are going to explain to their people why we are taking their money. So they need to be educated themselves.



Executive Secretary of the National Health Insurance Scheme (NHIS), Prof. Usman Yusuf (middle); Chairperson of Avon Healthcare Limited/Chief Executive Officer of Avon Medical Services Limited and overseer of the healthcare investments of Heirs Holdings, Dr. Awele Vivien Elumelu (right); and Managing Director/Chief Executive Officer of Avon Healthcare Limited (Avon HMO), Adesimbo Ukiri at a meeting of the Standing Committee of NHIS and the Health Maintenance Organizations (HMOs) in Abuja

“So it is our responsibility to go and advocate and talk on behalf of the enrollee why they should be mandated? How much should it cost? What will be the benefit? We have a lot of work in front of us and I am just three weeks in this business and that is why I am here.”

How are you going to address the many challenges of the enrollee? The NHIS boss explained: “These are legacy issues I met. It is going to be a very slow thing reaching out to people and telling them that we are all partners. I cannot do this alone; I need you all. It is me educating the public, telling them where we are, this is our fault and this is how we can get better for people to trust us again and educating people because a lot of people do not know about the scheme.

“It is our responsibility, nobody else’s to go and educate the people about the scheme. So it is our responsibility and that is why I am going out to see anybody that matters: the governors, the emirs, the clerics, the students, the vice chancellors, and the chief medical directors. I have a lot of work to do; I hope you come with me. You are partners in this.”

Some of the HMOs are calling for the equitable distribution of lives especially from workers in the formal sector. How is that going to happen? Yusuf said: “You see when the NHIS happened there were very few HMOs and it was the NHIS that distributed lives that is enrollees to those HMOs and helped them to start and they have over time grown and they have grown bigger. So new ones have come and they want piece of the lives. It I just like the old banks and the new banks.

“The new banks could not have survived if they have not been innovative. The GT Banks and the Zeniths are good on the Internet but if the old banks remained like that they will fizzle out. What I encourage the new HMOs to do is to be innovative, be nimble. No more free lunch: Not from us nor from the government. They need to go out, market themselves and get more lives, end of story.”

What does Avon intend to do in the next five years to increase the number of enrollees and getting better towards achieving Universal Health Coverage (UHC)? Elumelu said: “I think to a large extent what we need to do is that there a big problem of trust and transparency. Until we can overcome that, it will be a problem. So what do we need to do? We need to put steps in place. To increase the trust in us we need to be out there more transparent, let people see our financial credibility. Let people know our financial capacity and that way they know that they are sure where they are putting their money, they are sure of where they are going.

“So we need to do things like that. We need to make sure that even on the level of NHIS, there is proper monitoring, there is proper account keeping, account taking and to ensure that there is equitable distribution of the funds even within the NHIS because we have a lot of people who do not actually trust the system. They believe it is not done equitably so they are not happy be it government, be it private. So they need to make sure at that level you build that trust, you build that confidence in the system. And with that we will have the spread, we will have the increase coverage and so on.”

The NHIS indicted the HMOs on the issue of corrupt practices and inefficiency. Do you agree with that? Elumelu said: “To some extent that is certainly the case but I think the problem has partly been lack of oversight on the part of the regulators. Now that we have as it is the new Sheriff in town, we have a new broom which is still clean they are going to ensure that there is enforcement, which laws are there but they just haven’t been enforced.

“But you know if have no one enforcing things, what gets done is what is being measured and what is being checked. So now that we have a new person there that will say these things I going to insist that they are been done, we will see a change. We will see an end to seeming corruption that has been in the system, the seeming lack of work and the seeming people ignoring the enrollees; that way there will be a change for sure.”

How is your experience in Heirs Holding impact your work in Avon HMO in terms of meeting your mandate on UHC? The Avon HMO boss said: “Basically the main vision driving Heirs Holdings is that the group recognizes that the private sector has to take a role, take up its own role in improving the economy. So that is the main vision driving Heirs Holding.

“For us, we are in the health sector and we all know health is wealth. So as a private player in the health sector, we know that we in our own way will contribute our own quota to the health of the individual and therefore the health of the economy.”

The Guardian

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NHIS charges HMOs to be innovative, flexible